International medical volunteering in Peru: do they need us?
January 11, 2018 |
The first leg of a whirlwind trip through the five countries most commonly frequented by medical service trip volunteers in Latin America. I’m in Peru (which currently counts 59 organizations listed in our database – but I am well away from the well-trodden Cusco-Machu Picchu backpacker trail. Instead, my first stop is the northern desert city of Trujillo, where I am taking Spanish lessons with the Medical Elective Network.
My accomodation consists of a homestay with Elizabeth and Antonio. Betty, a nurse, leads the primary care team at the government hospital. Her husband is an industrial engineer at the university. Together, they occupy an uncommonly large house, running quite a tidy and friendly business hosting students and health professionals.
As for the Spanish school, my teacher is a Peruvian medical intern named Dra. Lorena. Having completed her seven year program, she has now moved on to her servicio rural, or rural service. This means that she must complete a year of pro bono work in a remote mountain village before becoming eligible for residency. With the servicio rural comes the incredible responsibility of managing medical care in the village, with little to no backup. There is an ultrasound available at a tiny hospital an hour away, but no other imaging. The eight days a month she spends in the mountains are unpaid – hence her side gig as a Spanish tutor.
How does the healthcare system work in Peru?
There are three separate health systems in Peru. They operate more or less in parallel.
1. Ministerio de Salud, affectionately known as MinSa. The creaky public system covers Peruvians who operate in the informal economy – which is to say most Peruvians. My host initially explains that it is free, but in reality patients pay for everything from their prescriptions, to their intravenous solutions, to their dressing changes. Also, it’s badly overstretched, and not very good. You might end up squeezing the bag for your intubated relative for upwards of a day, if there are no ventilators available.
2. Seguridad Social, a worker-funded and government-managed program that covers those Peruvians with formal employment. It’s a definite improvement over MinSa, for those in the middle class. Visits are free, unless you count the money disappearing from your paycheque.
3. Privado, or private. The sky is the limit. If you have the money to pay astronomical sums for your surgery and medical care, then you can have at it.
Welcome to the MinSa Emergency Room
Hospital Regional Docente de Trujillo is the largest MinSa hospital in town, receiving fully – wait for it – 75 emergency visits per day. For comparison, my busy emergency room in a mid-sized Canadian city receives over two hundred visits most days. The wait times in the regional hospital are around 30 minutes, although no one keeps track of this. I point out to Dra. Lorena’s surprise that at home, patients frequently wait six hours before the physician even lays eyes on them.
There doesn’t seem to be any particular triage system beyond the walking wounded arriving at the desk one by one, demanding to see a physician. When this happens, between five and six interns and residents casually look up from their charting. I count thirteen beds in the ER, but there don’t appear to be any beds for newly arriving patients.
At least in this MinSa hospital, both my eyes and the perception of the Peruvian physicians seem to indicate that there is no pressing staffing problem. There is a problem with the distribution of those personnel (hence the need for the mandatory servicio rural), and moreover, a problem with resource availability.
What does all this mean for medical service trips, where hundreds of volunteers arrive expecting that Peru lacks the medical expertise to care for its people? It’s complicated.
Next: Medicine outside the hospital gates
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